Overview
The scapula (shoulder blade) is a flat bone surrounded by muscle that forms the back of the shoulder joint. Because the scapula is well-protected by soft tissue, most fractures are minimally displaced and heal without surgery.
Surgical fixation is reserved for significantly displaced or angulated fractures, glenoid fractures that disrupt the joint surface, and injuries that alter shoulder mechanics. A small subset of scapular body and neck fractures benefits from surgery based on shortening, angulation, and combined upper-extremity injury patterns.
Why it's done
Scapula ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Displaced glenoid fracture
Joint-surface step-off leads to shoulder instability and arthritis.
Displaced or angulated scapular neck or body fracture
Significant mal-rotation affects the scapulohumeral rhythm.
Floating shoulder
Combined scapular neck and clavicle fracture warrants fixation.
Open fracture
Urgent debridement and stabilization.
How it works
Posterior (Judet-type) approach is used for scapular body and neck fractures. Plate fixation is applied along the lateral border and spine of the scapula, contoured to match the bone's complex curves.
Displaced glenoid fractures are approached either posteriorly or anteriorly depending on the fragment location. Screws or small plates restore the joint surface.
Recovery
The arm is protected in a sling with early passive and active-assisted shoulder motion. Active motion progresses as the repair consolidates, with strengthening added further along. Full recovery is gradual, with milestones your surgeon will discuss at follow-up. Scapular winging and persistent shoulder pain are known complications. Hardware is left unless symptomatic.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a scapula that heals malaligned with loss of glenohumeral mechanics — scapulothoracic motion suffers and overhead activity becomes painful. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before scapula orif include:
- bleeding and infection
- anesthesia risk
- suprascapular or axillary nerve irritation from the exposure
- stiffness
- hardware irritation
- blood clot (rare in upper-extremity surgery)
- non-union (uncommon)
The indication to proceed is a displaced glenoid or scapular-body fracture that meets operative criteria — most scapula fractures are treated non-operatively, so this is a specific subset. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: